Oregon Evidence-based Practice Center, Oregon Health & Science University, Mailcode BICC, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239-3098, USA.
Ann Intern Med. 2012 Jul 17;157(2):104-13. doi: 10.7326/0003-4819-157-2-201207170-00466.
Menopausal hormone therapy to prevent chronic conditions is currently not recommended because of its adverse effects.
To update evidence about the effectiveness of hormone therapy in reducing risk for chronic conditions and adverse effects, and to examine whether outcomes vary among women in different subgroups.
MEDLINE (January 2002 to November 2011), Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the 3rd quarter of 2011), Scopus, and reference lists.
Randomized, placebo-controlled trials of menopausal hormone therapy published in English since 2002 that assessed primary prevention of chronic conditions.
Investigators extracted data on participants, study design, analysis, follow-up, and results; 2 investigators independently rated study quality by using established criteria.
9 fair-quality trials met the inclusion criteria. The Women's Health Initiative reported most of the results, had 11 years of follow-up, and had data most applicable to postmenopausal women in the United States. It showed that estrogen plus progestin therapy reduced fractures (46 fewer per 10 000 woman-years) and increased invasive breast cancer (8 more per 10 000 woman-years), stroke (9 more per 10 000 woman-years), deep venous thrombosis (12 more per 10 000 woman-years), pulmonary embolism (9 more per 10 000 woman-years), lung cancer death (5 more per 10 000 woman-years), gallbladder disease (20 more per 10 000 woman-years), dementia (22 more per 10 000 woman-years), and urinary incontinence (872 more per 10 000 woman-years). Estrogen-only therapy reduced fractures (56 fewer per 10 000 woman-years), invasive breast cancer (8 fewer per 10 000 woman-years), and death (2 fewer per 10 000 woman-years) and increased stroke (11 more per 10 000 woman-years), deep venous thrombosis (7 more per 10 000 woman-years), gallbladder disease (33 more per 10 000 woman-years), and urinary incontinence (1271 more per 10 000 woman-years). Outcomes did not consistently differ by age or comorbid conditions.
Limitations of the trials included low adherence, high attrition, inadequate power to detect risks for some outcomes, and evaluation of few regimens.
Estrogen plus progestin and estrogen alone decreased risk for fractures but increased risk for stroke, thromboembolic events, gallbladder disease, and urinary incontinence. Estrogen plus progestin increased risk for breast cancer and probable dementia, whereas estrogen alone decreased risk for breast cancer.
Agency for Healthcare Research and Quality.
由于存在不良反应，目前不推荐使用激素替代疗法来预防慢性疾病。
更新关于激素替代疗法在降低慢性疾病风险和不良反应方面的有效性的证据，并研究不同亚组女性的结局是否存在差异。
MEDLINE（2002 年 1 月至 2011 年 11 月）、Cochrane 对照试验中心注册库和 Cochrane 系统评价数据库（截至 2011 年第 3 季度）、Scopus 和参考文献列表。
自 2002 年以来发表的评估激素替代疗法在预防慢性疾病中的作用的随机、安慰剂对照试验。
调查人员提取了参与者、研究设计、分析、随访和结果的数据；2 名调查人员使用既定标准独立评估研究质量。
9 项质量中等的试验符合纳入标准。妇女健康倡议报告了大部分结果，随访时间为 11 年，且数据最适用于美国的绝经后妇女。结果显示，雌孕激素联合治疗可降低骨折（每 10000 名妇女年减少 46 例）和增加浸润性乳腺癌（每 10000 名妇女年增加 8 例）、中风（每 10000 名妇女年增加 9 例）、深静脉血栓（每 10000 名妇女年增加 12 例）、肺栓塞（每 10000 名妇女年增加 9 例）、肺癌死亡（每 10000 名妇女年增加 5 例）、胆囊疾病（每 10000 名妇女年增加 20 例）、痴呆（每 10000 名妇女年增加 22 例）和尿失禁（每 10000 名妇女年增加 872 例）。单纯雌激素治疗可降低骨折（每 10000 名妇女年减少 56 例）、浸润性乳腺癌（每 10000 名妇女年减少 8 例）和死亡（每 10000 名妇女年减少 2 例），并增加中风（每 10000 名妇女年增加 11 例）、深静脉血栓（每 10000 名妇女年增加 7 例）、胆囊疾病（每 10000 名妇女年增加 33 例）和尿失禁（每 10000 名妇女年增加 1271 例）。结局在年龄或合并症方面并不始终存在差异。
试验的局限性包括低依从性、高脱落率、检测某些结局风险的能力不足以及评估方案较少。
雌孕激素联合治疗和单纯雌激素治疗均可降低骨折风险，但增加中风、血栓栓塞事件、胆囊疾病和尿失禁的风险。雌孕激素联合治疗增加了乳腺癌和可能的痴呆风险，而单纯雌激素治疗降低了乳腺癌风险。
美国医疗保健研究与质量局。
